Document Detail


Diagnostic ultrasound combined with glycoprotein IIb/IIIa-targeted microbubbles improves microvascular recovery after acute coronary thrombotic occlusions.
MedLine Citation:
PMID:  19255341     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The high mechanical index (MI) impulses from a diagnostic ultrasound transducer may be a method of recanalizing acutely thrombosed vessels if the impulses are applied only when microbubbles are channeling through the thrombus. METHODS AND RESULTS: In 45 pigs with acute left anterior descending thrombotic occlusions, a low-MI pulse sequence scheme (contrast pulse sequencing) was used to image the myocardium and guide the delivery of high-MI (1.9 MI) impulses during infusion of either intravenous platelet-targeted microbubbles or nontargeted microbubbles. A third group received no diagnostic ultrasound and microbubbles. All groups received half-dose recombinant prourokinase, heparin, and aspirin. Contrast pulse sequencing examined replenishment of contrast within the central portion of the risk area and guided the application of high-MI impulses. Angiographic recanalization rates, resolution of ST-segment elevation on ECG, and wall thickening were analyzed. Pigs receiving platelet-targeted microbubbles had more rapid replenishment of the central portion of the risk area (80% versus 40% for nontargeted microbubbles; P=0.03) and higher epicardial recanalization rates (53% versus 7% for prourokinase alone; P=0.01). Replenishment of contrast within the risk area (whether with platelet-targeted microbubbles or nontargeted microbubbles) was associated with both higher recanalization rates and even higher rates of ST-segment resolution (82% versus 21% for prourokinase alone; P=0.006). ST-segment resolution occurred in 6 pigs (40%) treated with microbubbles who did not have epicardial recanalization, of which 5 had recovery of wall thickening. CONCLUSIONS: Intravenous platelet-targeted microbubbles combined with brief high-MI diagnostic ultrasound impulses guided by contrast pulse sequencing improve both epicardial recanalization rates and microvascular recovery.
Authors:
Feng Xie; John Lof; Terry Matsunaga; Reena Zutshi; Thomas R Porter
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural     Date:  2009-03-02
Journal Detail:
Title:  Circulation     Volume:  119     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2009 Mar 
Date Detail:
Created Date:  2009-03-17     Completed Date:  2009-04-16     Revised Date:  2010-09-22    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1378-85     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198-2265, USA. fxie@unmc.edu
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MeSH Terms
Descriptor/Qualifier:
Animals
Combined Modality Therapy
Coronary Angiography
Coronary Thrombosis / radiography,  therapy*,  ultrasonography
Electrocardiography
Hemodynamics
Microbubbles*
Microcirculation
Myocardial Reperfusion / instrumentation,  methods*
Myocardium / pathology
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
Random Allocation
Recombinant Proteins / therapeutic use
Sus scrofa
Ultrasonic Therapy / instrumentation,  methods*
Urokinase-Type Plasminogen Activator / therapeutic use
Grant Support
ID/Acronym/Agency:
2R44HL071433-02/HL/NHLBI NIH HHS; R44 HL071433-02/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Platelet Glycoprotein GPIIb-IIIa Complex; 0/Recombinant Proteins; 99149-95-8/saruplase; EC 3.4.21.73/Urokinase-Type Plasminogen Activator
Comments/Corrections
Comment In:
Circulation. 2009 Mar 17;119(10):1358-60   [PMID:  19255337 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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